VMG Waiver Form

COVID-19 Waiver

The Releasees shall not be liable to make any payment in respect of any claim(s) or circumstance(s) or loss(es) or other matter(s) from you registering in or participating in wilderness activities and arising out of, related to, connected to, or in any way involving, directly or indirectly:

a. Coronavirus disease (COVID-19);

b. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2);

c. any mutation or variation of COVID-19 or SARS-CoV-2;

d. any fear or threat (whether actual or perceived) of a), b) or c) above;

e. any action taken to control, prevent, suppress, mitigate or in any way relating to any actual or suspected outbreak of any of a), b) or c).

It is further agreed that the Releasees shall not be liable to make any payment in respect of claim(s) or circumstance(s) or loss(es) or other matter(s) from registering in or participating in wilderness activities that arises as a result of, or is connected in any way, directly or indirectly, with any consequential loss or financial impairment suffered by yourself or any third party as a result of any of a), b), c), d) or e) above. The Releasees maintain that this release of liability waiver applies and the burden of proving that it does not and all costs associated are paid by you.

Today's date: November 20, 2024

Type Signature

Draw Signature

Please select who will be participating...

Adult Minor(s)
1 Minor 2 Minors 3 Minors 4 Minors 5 Minors More Minors 6 Minors 7 Minors 8 Minors 9 Minors 10 Minors

Continue

First Participant's Name

First Name*

Last Name*

Phone*

First Participant's Date of Birth*

First Participant's Signature*

Type Signature

Draw Signature

Second Participant's Name

First Name*

Last Name*

Phone*

Second Participant's Date of Birth*

Third Participant's Name

First Name*

Last Name*

Phone*

Third Participant's Date of Birth*

Fourth Participant's Name

First Name*

Last Name*

Phone*

Fourth Participant's Date of Birth*

Fifth Participant's Name

First Name*

Last Name*

Phone*

Fifth Participant's Date of Birth*

Sixth Participant's Name

First Name*

Last Name*

Phone*

Sixth Participant's Date of Birth*

Seventh Participant's Name

First Name*

Last Name*

Phone*

Seventh Participant's Date of Birth*

Eighth Participant's Name

First Name*

Last Name*

Phone*

Eighth Participant's Date of Birth*

Ninth Participant's Name

First Name*

Last Name*

Phone*

Ninth Participant's Date of Birth*

Tenth Participant's Name

First Name*

Last Name*

Phone*

Tenth Participant's Date of Birth*

Participant's Address

Address Line 1:*

Street address, P.O. box, company name, c/o

Address Line 2:

Apartment, suite, unit, building, floor, etc.

Country:*

City:*

State/Province:*

Zip/Postal:*

Parent or Guardian's Email Address

Email*

Confirm Email*

Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*

Medical Information:

Medical conditions (Heart attack, high blood pressure, diabetes, arthritis, seizures)?*

Yes

Please list anything here.

Allergies (bee stings, pollen, nuts, penicillin, morphine)?*

Yes

Please list anything here.

Medications (high blood pressure, antibiotics, blood thinners, insulin)?*

Yes

Please list anything here.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above, and;

1. I am satisfied that I have been informed of my right to obtain as much information about this program,

or activity as I feel necessary, including information beyond that information provided to me by the

Lead Guide/Instructor to the extent that I require and am not, in any way, relying solely upon

information provided by the Lead Guide/Instructor respecting the nature and extent of the risks and

hazards associated with the program or activity.

2. I freely and voluntarily assume the risks and hazards inherent in the nature of the program or activity

and understand and acknowledge that my child, as a participant, may suffer personal and potentially

serious injury or death due to an accidental event.

3. My child has been informed that he/she/they must abide by the rules and regulations including

directions and instructions from the relevant land agency imposed on the minors while

participating in the program or activities. This shall include his/her/their participation in all of the

introductory sessions and the meeting of all prerequisites prior to his/her/their participation in the

activity or program.

4. In the event that my child fails to abide by the rules and regulations imposed on the participants while

participating in the program or activities, disciplinary action may either require that he/she/they

not participate in the program or activity, or that I will be contacted to have him/her/they picked up,

unless I have permitted my child to pursue alternate means of transportation, as appropriate.

5. I acknowledge that it is my responsibility to advise the Lead Guide/Instructor of any medical or health

concerns of my child, which may affect his/her/their participation in the stated program or activity.

6. I understand that there is no provision for accidental death, dismemberment, disability or medical

expense insurance on behalf of my child or other participants in this activity.

7. I consent that the Lead Guide/Instructor may secure such medical advice and services as that

individual, in his/her/their sole discretion, may deem necessary for my child’s health and safety, and

that I shall be financially responsible for such advice and services.

8. Based on my understanding, acknowledgement and consents as described herein, I agree that

my child/youth has permission to participate in this program or activity under the supervision of the Lead Guide/Instructor.

By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.

Parent or Guardian's Name

First Name*

Last Name*

Phone*

Parent or Guardian's Date of Birth*

Parent or Guardian's Signature*

Type Signature

Draw Signature